Pre-cancer Treatments

What is an Actinic Keratosis (AK) or Pre-cancer?

AKs are pink, tan, or brown slightly raised rough areas that generally appear on the hands, arms, and face. They may also appear on the upper chest and back, bald areas of the scalp, and even along the rim of the ear. AKs are sometimes flesh-colored and are more easily felt than seen. Sizes vary from microscopic to several inches in diameter. If left untreated, AKs eventually progress to skin cancer (squamous cell carcinoma) over several years.

What causes them to occur?

AKs are most commonly caused by repeated or long-term exposure to the sun’s harmful rays. They appear when, after many years, sun damage causes skin cells to grow at an abnormally rapid rate. Early detection and treatment are key to maintaining good skin health.

How do I treat them?

  • Cryotherapy (freezing the area) which has a slightly higher risk of developing a white spot.
  • Fluorouracil Creams (Effudex or generic fluorouracil apply 2 x per day – Carac apply 1 x per day) or):
    Fluorouracil is a topical chemotherapy that specifically targets and eliminates abnormal AK cells. It attacks visible lesions as well as those not visible to the naked eye.
    A very small amount is to be applied to the pre-cancer and the surrounding margin of skin each day. It is best to apply to clean skin several hours prior to bed. In the morning, wash off and apply sun-block if you plan to be outdoors. The process may be continued for 1 to 4 weeks depending on your physician’s instructions. We recommend follow-up at 2 weeks if it is your first time using so we can guide you with appropriate timing. Often an anti-inflammatory cream is recommended for treatment.
  • Imiquimod Creams: Aldara and Zyclara:
    Aldara/Zyclara work from within by activating your body’s own immune system to help clear visible lesions and those not visible to the eye. The percent of active medication is higher in Aldara and as a result the dosing regimen is different.
    Directions for Aldara:
    A very small amount is to be applied to the pre-cancer and the surrounding margin of skin 2 times per week. It is best to apply to clean skin several hours prior to bed. This process may be continued for up to 16 weeks dependent upon your physician’s instructions.
    Directions for Zyclara:
    A very small amount is to be applied to the pre-cancer and surrounding margin of skin daily for 2 weeks. You will then stop applying the medication for 2 weeks, and then restart daily application for another 2 weeks. It is best to apply to clean skin several hours prior to bed.
  • Solaraze:
    Slow acting anti-inflammation cream.
    Directions for Solareze: Use twice a day, every day for up to 90 days as directed.
  • Picato:
    Topical gel that promotes cell death in both visible and non-visible pre-cancerous cells. It is prescribed in different strengths depending on body location.
    Directions for Picato:
    Use a very small amount of .015% strength for face/scalp for 3 consecutive days.
    Use a very small amount of .05% strength for body, arms, legs for 2 consecutive days.

Normal Reactions to AK Medications:

Reactions may vary, but the typical reaction to all of these creams may include: mild redness, burning, itching, peeling, and crusting around the area that medication is being applied. Such inflammatory reactions usually begin during the first week of therapy and may become more severe during the next several weeks. These reactions often indicate that your medication is working, so don’t stop using it. If you do develop severe irritation, pain, bleeding, or pus-like discharge, call your doctor to be certain you do not need an earlier follow-up appointment or need to stop the medication earlier than planned. After the reaction levels off, healthy new skin cells will replace sundamaged cells and your skin’s natural appearance will be restored. The reaction to these creams in treated areas may be unsightly during therapy and in some cases for several weeks after therapy. Continue wearing sun-block on the treated area as it continues to heal.


  • Avoid sunlight or other ultraviolet light (such as tanning booths). If it is necessary to be in sunlight, wear protective clothing and use
    sunscreen with SPF 30 or above.
  • Do not cover treated area with a dressing. This may concentrate the medication causing a more severe reaction.
  • Do not breast-feed or become pregnant while using this medication. If you do become pregnant during treatment, immediately stop
    treatment and inform your physician.
  • If any severe irritation, pain, bleeding, or pus-like discharge occurs, call the office prior to the scheduled follow up.
  • A follow-up appointment of 2 weeks is advised for patients who have not used these medications before.